Basic Information
| Provider Information | |||||||||
| NPI: | 1992992341 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINJUM | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3585 BUCHANAN ST S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581047508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013884604 | ||||||||
| FaxNumber: | 2182330003 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 COUNTY RD 34 | ||||||||
| Address2: | ARTHUR GOOD SAMARITAN CENTER | ||||||||
| City: | ARTHUR | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580064100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7019678316 | ||||||||
| FaxNumber: | 7019678961 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2007 | ||||||||
| LastUpdateDate: | 10/01/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 792 | ND | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 103188 | MN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.